The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers

Krieger, James; Takaro, Tim K.; Song, Lin; Weaver, Marcia R.

doi:10.2105/ajph.2004.042994

Cited by 362 publications

(329 citation statements)

References 41 publications

(43 reference statements)

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“…Although some studies have indicated that education alone is an effective intervention, the preponderance asthma intervention studies indicate that education alone has not been effective in changing parental behaviors that affect asthma risk factors (Krieger et al, 2005;Wu and Takaro, 2007). While our results do not markedly change this conclusion, it is notable during the intervention phase of this study that the short-term (6 weeks to 4 months) effect of education was indistinguishable from the effect of cleaning on allergen levels in subsequent pre-cleaning samples.…”

Section: Allergen Interventioncontrasting

confidence: 87%

“…Many studies, however, have not investigated the suite of allergens typically present in households, or the cost and effort involved in implementation, and many studies have expressed concerns about sustainability over time (Wu and Takaro, 2007). Given the multiple risk factors and increasing burden that asthma places on families and communities, it is important to test the efficacy of intervention strategies that affect the suite of common risk factors and can be implemented by a diverse population of residents, including those from low-income and/or non-English-speaking communities that bear the largest burden of this chronic disease (Takaro et al, 2004;Krieger et al, 2005;Levy et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

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Ramachandran

Cho

et al. 2007

J Expo Sci Environ Epidemiol

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Allergens in house dust are risk factors for asthma causation and exacerbation, and asthma interventions often focus on exposure reduction using methods that may not be sustainable over time in low-income communities. A randomized controlled trial with up to six home visits was used to evaluate the effectiveness of two interventions focused on reducing dust loading and allergen concentrations in 47 low-income inner-city households in Minneapolis, MN. The interventions, which included education and relatively inexpensive cleaning procedures, were developed using a community-based participatory consultation process with focus groups held in English, Somali, and Spanish to incorporate community feedback from participants into protocols and study design decisions. Change in levels of cat, cockroach, dust mite, and culturable fungi as well as overall dust loading were evaluated by measuring the difference in concentrations before and after the cleaning intervention, and mixed models were used to assess the effect of education and cleaning on baseline allergen levels during the final three home visits. The cleaning intervention significantly lowered dust loading in all households and culturable fungi levels in single family homes, reduced cat allergen concentrations in homes with cats, but had no significant effect on cockroach allergen levels. The cleaning intervention also modestly decreased the frequency of observed allergen concentrations above suggested health benchmarks for cat, cockroach, and fungi. The cleaning and education interventions had similar effects on baseline allergen levels measured during subsequent home visits; both interventions significantly reduced baseline levels of cat and fungal allergens observed in pre-cleaning samples, but had no significant effect on cockroach allergen levels. Overall, the cleaning intervention modestly reduced potential exposure to risk factors associated with asthma mortality and morbidity in a way that can be implemented by most homeowners or renters, independent of education, income, or the ability to speak English.

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Section: Allergen Interventioncontrasting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Adgate

Ramachandran

Cho

et al. 2007

J Expo Sci Environ Epidemiol

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“…Two of four RCTs demonstrated a significant decrease relative to control, 40,53 and two showed no significant decrease relative to control. 54,55 Of the four pre-post studies measuring this outcome, three demonstrated a statistically significant decrease, 41,44,45 and one showed a non-significant increase. 46 …”

Section: Emergency Department Visitsmentioning

confidence: 94%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS: Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION: Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

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“…There are significant benefits to integrating CHWs into the PCMH. Namely, clinical outcomes improve when CHWs are integrated into primary care teams [3][4][5][6][7]. Additionally, CHW-based interventions have demonstrated reduced health care use and costs for chronic care conditions [5,6,8,9].…”

Section: Purposementioning

confidence: 99%

Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home

Hynes

Buscemi

Quintiliani

2015

Behav. Med. Pract. Policy Res.

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The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers

Abstract: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Cited by 362 publications

References 41 publications

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home

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